Healthcare Provider Details

I. General information

NPI: 1689895120
Provider Name (Legal Business Name): TAMARA GOLDBERG PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 03/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 KINGS HWY
BROOKLYN NY
11223-1483
US

IV. Provider business mailing address

451 CLARKSON AVE
BROOKLYN NY
11203-2054
US

V. Phone/Fax

Practice location:
  • Phone: 718-245-5531
  • Fax:
Mailing address:
  • Phone: 718-254-5531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number050569
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: